– GOLD WINNER OF THE 2017 EXCELLENCE IN PRACTICE AWARDS –
Collaboration and exploration has resulted in the creation of an innovative intervention to improve the lives of thousands of people in the UK living with diabetes. Despite facing a seemingly impossible situation the programme is producing major improvements in diabetes healthcare delivery, has addressed highly complex challenges and failings, and has led to multiple tangible changes – all without putting any extra strain on the health system or adding a single penny to the budget
The context and challenge
The number of people living with diabetes in the UK has doubled in the past 10 years, standing today at 4.5million. This is putting immense strain on health and social care services, costing the National Health Service (NHS) £10 billion annually and is exposing both a lack of patient education as well as dangerously inadequate specialist knowledge among healthcare professionals.
Basic errors in medication, mistakes and misdiagnosis are all too common occurrences for people with diabetes and the latest figures (Diabetes UK State of the Nation 2016) are alarming: of all deaths from diabetes 80% are avoidable; diabetes is now the major cause of blindness in working age people; 80% of limb amputations are 100% preventable.
Completing the picture, healthcare professionals are demoralised and exhausted from the daily frustration of not being able to meet patients’ needs and deliver adequate levels of care while also cutting costs.
Furthermore, the ability of diabetes specialists to address the problems, to work outside their silos and roles, or even to build an understanding of the challenges across the diabetes pathway is nonexistent given the pressures, hierarchical nature and fragmented organisational structure of the NHS.
A critical situation in desperate need of a solution
In 2013, the charity Diabetes UK was grappling with the following question:
How do you go about making changes in healthcare delivery that will lead to real improvements for people living with diabetes given the stark realities, systemic factors, lack of adequate resources and education, and a worsening financial situation?
Despite being initially unclear on the way forward, a collaboration between Diabetes UK, Ashridge Executive Education and Novo Nordisk, a global pharmaceutical company specialising in diabetes, began a process of exploration.
As Amy Rylance, Head of Healthcare Professional Engagement, Diabetes UK explains “underpinning our partnership was the belief that change needed to happen from within and that diabetes specialists in the NHS see very clearly what needs to happen but lack the knowledge, support and authority to affect real change.” From this emerged the central idea of an initiative that for the first time brought together all elements of the diabetes pathway under the shared goal of making a genuine difference to diabetes healthcare. It led to the game-changing decision to recruit diabetes specialists from within the NHS into a new role as “Diabetes UK Clinical Champions”.
Tasked with the remit of taking on evidencebased change initiatives, diabetes nurses, dietitians, GPs, pharmacists, consultants and podiatrists would work together as a community to understand and address the obstacles and challenges and to make change happen. This would occur within a two-year working process of highly relevant learning and development and extremely high levels of practical, hands-on support from the partners.
Turning the shared vision into a reality
The first cohort was successfully recruited in 2014. Champions were chosen for their frontline experience (rather than formal position/hierarchy) and for their passion. This was an essential criterion given that the role was completely voluntary, would be “over and above” their current jobs, and offered without personal gain or formal promotion for participants. Despite being initially unsure if there would be any take-up for the role, the proposition, with its bold vision, development and support plan, offered healthcare professionals a glimmer of hope; a chance to make a difference, to change the downward spiral of worsening service provision in which they had found themselves and put patients first again.
“What happens outside the programme is why we’re all here.”
As the primary goal is to make a difference to diabetes care, there is an understanding by all involved that “what happens outside the programme is why we’re here”. The programme is therefore focused on enabling and empowering Champions to deliver change initiatives. The level of involvement from the partners in this process, both within and between each module – from practical resources and the provision of data, information, contacts and research findings to opening doors so that champions can engage policy decision makers directly – is far beyond that usually found in learning and development programmes. It means Champions never have to work in isolation or start from a blank page.
To ensure the development programme fully supported the overarching goals and Champions’ needs the first module (four in total, each just 24hours due to participants’ limited available time) was run as an open exploration with participants where shared learning and co-creation occurred.
Guy Lubitsh, Client Director at Ashridge, explains: “We didn’t want to make assumptions about what was really needed until Champions had been recruited and worked with at least once”.
The programme content addresses the specific challenges Champions will encounter as change agents within the UK healthcare system, including reaching out to complex groups, engaging patients and engaging local communities in change. Skill development is also highly relevant, from communicating business plans and stakeholder mapping to increasing personal impact, profile-raising and leadership resilience.
“Big players” from government and industry join the programme at key points to share their personal insights and shake-up misconceptions regarding leadership.
With the support, vision and development offered, the participants began to believe in themselves, imagining a different reality for diabetes care and growing the critical skills, confidence and understanding to lead change, influence across organisational boundaries, ensure diabetes is taken seriously, tackle ‘threats to care’ and deliver solutions. The acquired title of Diabetes UK Clinical Champion was the pivotal factor for success (many participants refer to it as “the magic hat”) that propelled each healthcare professional into being a leader and, crucially, gave them the credibility and authority they needed.
As a result of the initiative, diabetes healthcare has been improved in ways previously believed impossible. To date there have been four cohorts (65 Champions) and between them they have:
- addressed life-threatening practices
- improved inpatient safety
- prevented dangerous decisions being implemented
- reduced variations in care
- enabled patients to better control their diabetes
Specific examples of impact include:
- Reducing medication errors in a hospital from 46.9% to 26.7%
- Reducing instances of serious, sometimes fatal, hypoglycaemic episodes in a hospital from 15.5% to 6.9%
- Implementing new care guidelines
- Increasing the number of limb screenings from 77.8% to 91.3%
- Securing funding for a new role of Schools Educator in Wales
- Designing new staff training initiatives
- Delivering training to schools
- Reducing ambulance call-out numbers
As changes are experienced by professionals and patients up and down the country the energy, credibility and leadership of Champions for affecting positive change continues to grow. It’s a snowball effect that serves to enhance the work, the result being that more is achieved daily, even beyond the original scope of the work.
Extending into the wider world of policymaking, commissioning, public engagement and education, Champions attend meetings in Parliament, host MPs in their clinics to highlight pressing diabetes care issues and offer themselves up without hesitation when there is a big national news item, helping Diabetes UK to get important messages out to the public.
“It is wonderful to be working with Diabetes UK on this ambitious initiative aimed at empowering a growing network of Clinical Champions. These are inspiring individuals who wish to become advocates for change and quality improvement in diabetes services across the NHS.”
Adam Burt, Director of Market Access and Public Affairs at Novo Nordisk UK
The programme has proved to be an initiative that challenged the dominant narrative and scepticism surrounding public and private partnerships and which is putting the needs of people living with diabetes first.
It also offers others an adaptable model for solving highly complex challenges – particularly for organisations no longer able to rely solely on themselves or their own resources to do everything – and reminds us all of the power of collaboration and of new possibilities made real through shared vision, belief and inventiveness.